title: May early intervention with high dose intravenous immunoglobulin pose a potentially successful treatment for severe cases of tick-borne encephalitis?
abstract: BACKGROUND
  Arthropod-borne viral encephalitis of diverse origins shows similar clinical symptoms, histopathology and magnetic resonance imaging, indicating that the patho mechanisms may be similar. There is no specific therapy to date. However, vaccination remains the best prophylaxis against a selected few. Regardless of these shortcomings, there are an increasing number of case reports that successfully treat arboviral encephalitis with high doses of intravenous immunoglobulins.
  
  
  CONCLUSIONS
  To our knowledge, high dose intravenous immunoglobulin has not been tested systematically for treating severe cases of tick-borne encephalitis. Antibody-dependent enhancement has been suspected, but not proven, in several juvenile cases of tick-borne encephalitis. Although antibody-dependent enhancement during secondary infection with dengue virus has been documented, no adverse effects were noticed in a controlled study of high dose intravenous immunoglobulin therapy for dengue-associated thrombocytopenia. The inflammation-dampening therapeutic effects of generic high dose intravenous immunoglobulins may override the antibody-dependent enhancement effects that are potentially induced by cross-reactive antibodies or by virus-specific antibodies at sub-neutralizing levels.
  
  
  CONCLUSIONS
  Analogous to the increasing number of case reports on the successful treatment of other arboviral encephalitides with high dose intravenous immunoglobulins, we postulate whether it may be possible to also treat severe cases of tick-borne encephalitis with high dose intravenous immunoglobulins as early in the course of the disease as possible.
authors.affiliation: Academy of Sciences of the Czech Republic, Biology Centre, Institute of Parasitology, Branisovska: 31, CZ-37005 Ceske Budejovice, Czech Republic.
authors.forename: Daniel
authors.initials: D
authors.lastname: Růžek
authors.forename: Gerhard
authors.initials: G
authors.lastname: Dobler
authors.forename: Hans Helmut
authors.initials: HH
authors.lastname: Niller
mesh_terms: D000914:Antibodies, Viral / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D004675:Encephalitis, Tick-Borne / Q000276:immunology / Q000628:therapy* / Q000821:virology*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D008297:Male; D008875:Middle Aged
chemical_list: D000914:Antibodies, Viral; D016756:Immunoglobulins, Intravenous